NRHM Assam, Initiative and Innovations

1. National Rural Health Mission
Department Of Community Medicine
Gauhati Medical College
Dr. Ramkesh Prasad
Dr. Ashok Jyoti Deka

2. Goals
 Reduction in Infant Mortality Rate (IMR) and Maternal Mortality
Ratio (MMR)
 Universal access to public health services such as Women’s
health, child health, water, sanitation & hygiene, immunization,
and Nutrition.
 Prevention and control of communicable and non-
communicable diseases, including locally endemic diseases
 Access to integrated comprehensive primary healthcare
 Population stabilization, gender and demographic balance.
 Revitalize local health traditions and mainstream AYUSH
 Promotion of healthy life styles

3. Expected outcomes of the Mission
 IMR reduced to 30/1000 live births Material Mortality reduced to
100/100,000 TFR reduced to 2.1 by 2012.
 Malaria Mortality Reduction Rate - 50% up to 2010, additional 10% by 2012.
 Kala Azar Mortality Reduction Rate - 100% by 2010, sustaining elimination
until 2012.
 Filaria/Microfilaria Reduction Rate - 70% by 2010, 80% by 2012 and
elimination by 2015.
 Dengue Mortality Reduction Rate - 50% by 2010 and sustaining at that level
until 2012.
 Cataract operations - increasing to 46 lakhs until 2012.
 Leprosy Prevalence Rate –reduce less than 1 per 10,000 thereafter.
 Tuberculosis DOTS series - maintain 85% cure rate through entire Mission
Period.
 Upgrading Community Health Centers to Indian Public Health Standards.
 Increase utilization of First Referral Units from less than 20% to 75%.

4. Components of NRHM
 1. RCH – II
 2. NRHM Additionalities
 3. Immunization
 4. National Programmes
 5. Mainstreaming of AYUSH

6. Major Stakeholders
 Accredited Social Health Activist (ASHA)
 Anganwadi worker (AWW)
 Auxiliary Nurse Midwife / Health Worker (female)
 Panchayati Raj Institutions and NGOs
 District Administration
 State Governments

7. Plan of Action
 Accredited Social Health Activists
 Strengthening Sub-Centres
 Strengthening Primary Health Centres
 Strengthening CHCs for First Referral Care
 District Health Plan
 Converging Sanitation and Hygiene under NRHM
 Strengthening Disease Control Programmes
 Public-Private Partnership for public health goals, including
regulation of private sector
 New health financing mechanisms
 Reorienting health/medical education to support rural health
issues

8. Village level
 ASHA
 Accredited Social Health Activist
 Female activist given accreditation after 4 phase training
 ASHA would act as a bridge between the ANM and
the village and be accountable to the Panchayat.
 Ownership of health program given to villagers
 Village Health Committee prepares Village Health
Plan

9. District Level
 District health plan generated by combining village
health plans
 Elements are drinking water, sanitation, hygiene and
nutrition
 Strengthening Sub Centers, Primary Health Centers
and Community Health Centers

10. Monitoring and Evaluation
 Health MIS to be developed up to CHC level, and web-enabled for
citizen scrutiny (October, 2008)
 Sub-centres to report on performance to Panchayats, Hospitals to Rogi
Kalyan Samitis and District Health Mission to Zila Parishad
 The District Health Mission to monitor compliance to Citizen’s
Charter at CHC level
 Annual District Reports on People’s Health (to be prepared by
Govt./NGO collaboration)
 State and National Reports on People’s Health to be tabled in
Assemblies, Parliament
 External evaluation/social audit through professional bodies/NGOs
 Mid Course reviews and appropriate correction

11. NRHM – What is the Impact
* SRS
# NFHS
Infant Mortality Rate * 60 (2003) 53 (2008)
Maternal Mortality Ratio #
301 (2001-03) 254 (2004-06)
Total Fertility Rate #
2.9 (2005) 2.7 (2007)
Institutional Delivery
Fully Immunized Children
Unmet needs of Family
Planning

12. Janani Suraksha Yojana
 Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the
National Rural Health Mission (NRHM) being implemented with the
objective of reducing maternal and neo-natal mortality by promoting
institutional delivery among the poor pregnant women. The Yojana, launched
on 12th April 2005 is being implemented in all states and UTs. The Yojana is
being implemented in all states and Union Territories. JSY is a 100% centrally
sponsored scheme.
 The Yojana has identified ASHA, the Accredited Social Health Activist as an
effective link between the Government and the poor pregnant women in 10
low performing states, namely the 8 (EAG) - Empowered Action Group
(EAG) states and Assam and J&K and the remaining NE States. Her main
role is to facilitate pregnant women to avail Services of maternal care and
arrange referral transport.
 The scheme focuses on the poor pregnant woman with special dispensation
for states having low institutional delivery rate. Besides the maternal care, the
scheme provides cash assistance to all eligible mothers for delivery care.

13. NRHM – Other Improvements
Key findings in DLHS – III (2007-08)
 53.1% PHC working 24 hours basis
 90.1% CHC have 24 hours normal delivery services
 90.6% Sub Centres with ANM
 19.2% PHCs with AYUSH doctors
 90.7% villages have JSY beneficiaries
 Full immunisation up to 54.1%
 Institutional Delivery up to 47%

14. Improvements in No. of Institutional Deliveries
DLHS-2 (2002-04) 23.20 %
DLHS-3 (2007-08) 35.30%
*Concurrent Evaluation Survey, 2009, Regional Resource Center-NE, Ministry of Health
& Family Welfare, Govt. of India = 66.30%

15. Innovations
Boat Clinic – Ship of Hope
•Launched on 11th November ’07
•Operational in 27 districts
•Equiped with Microscope,
SemiAuto Analyser, Generator,
•Medical Officers, Nurses,
Technicians,

16. Boat Clinic - For the marginalized million
 Launched on 25th May 2005 on National Immunisation
Day – Pulse Polio Immunisation in Bogibeel, Dibrugarh
 MoU signed between NRHM and Centre for North
East Studies and Policy Research (C-NES) in 2008
 Operational in Dibrugarh, Tinsukia, Morigaon,
Dhemaji, Dhubri, Nalbari, Barpeta, Jorhat, Sonitpur,
and Lakhimpur
 Services offered: OPD services, ANC, Immunisation,
Family planning, Minor operative procedures, Basic
Laboratory Services
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17. Mobile Medical Unit
Hospital on Wheels
•Launched on 11th November ’07
•Operational in 27 districts
•Equipped with Microscope,
SemiAuto Analyser, Portable X-ray,
USG, ECG, Generator
•2 MO, Nurses, Technicians…
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18. ASHA Radio
•Updating the ASHAs with new development and also informing them about the
mission for upgrading the standard of life of the rural people in respect to health
and hygiene and particularly promoting the healthy environment for mother and
child
•Feedback Mechanism : Pre paid post cards with printed address of office of the
AIR, Each ASHA will be given 12 postcards
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19. ANM Mobile
•Can report any suspected cases to the PHC to take
immediate action before it results to outbreak.
• Can also facilitate for the referral transport so that
people can avail the facility as there are villages where
public transportation facility is not available.
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20. Compulsory Rural posting of Doctors in
Assam
 768 doctors were given appointment across the
State at different MPHCs/ SDs / SHCs / in few
BPHCs & CHCs having less or no doctors
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21. Rural Health Practitioners
by Assam Rural Health Regulatory Act in 2004
The main objectives behind introducing this act are:
 To increase trained manpower for rural areas and in the health
sector.
 To bridge the gap between doctors working in the PHC and the
outreach section of people of rural community.
 To ease implementation of Govt. health programme efficiently.
 To fill up the vacant posts of proper health personnel in rural
areas.
 Regularization of trained manpower will minimize the practice of
village quacks and self-made doctors in those areas spreading
unscientific knowledge of health.
 The first batch of 92 RHP has been posted in the
PHC/MPHC/SD/SHC located in the remotest areas of the
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22. Initiative in Assam
 Mamoni
 Majoni
 Marom

23. Majoni - Assistance to Girl Child
An initiative under Assam Bikas Yojna (ABY)
 The birth of the girl child must be Institutional
 The birth will have to be registered
 Families conforming to the Govt. Policy of Two
Children only will be eligible.
 The FD will be issued by the designated bank. Girl
child and the date of maturity will be the eighteenth
birthday of the girl (i.e. after completion of 18years).
 The Girl should not be married before attaining 18
years.
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24. Mamoni -Nutritional Supplement for Pregnant
Women
An initiative under Assam Bikas Yojna (ABY)
 Every pregnant woman gets Rs. 1000/ for taking
nutritious food.
 During the registration the pregnant women receives
Mamoni Booklet comprising information on the care and
management of pregnancy and the new born.
 During her 1stANC,the pregnant woman receives an
A/C payee cheque of Rs. 500/-
 During her 3rd ANC, she gets another cheque of Rs.
500/- along with a voucher for the referral transport.
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25. Evening Out Patient Department
 An initiative by Government of Assam to provide
round-the-clock medical services to the people of
the state.
 Launched on 6th May, 2008 to make the govt.
health care facilities accessible and available to the
rural people beyond routine OPD hours as the
timing of the OPD is as per the convenient of the
community (i.e. 5 pm to 8 pm).
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26. Emergency Management
& Referral Transport
 Looking at the demand for comprehensive emergency system Govt. of Assam
has entered into a MoU with the EMRI, Hyderabad on 8th July, 2008.
 The 108 Mrityunjoy Emergency Response Services was formally inaugurated
on 6th November, 2008 at Guwahati.
The objective of the partnership
 to improve access of the general public to services like Medical, Police and
Fire. There are in
 Total 280 Advance Life Saving (ALS) ambulances covering all 27 districts.
 The 108 Mrityunjoy Emergency Response Services is 24 x 7 functional with
dedicated team members. Dialing ‘108’ the toll free emergency number, the
emergency call lands at Emergency Response Centre (ERC).
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27. PPP with Tea Garden Hospitals
Objectives
 To provide health care services to the tea garden worker s& non-workers;
 To strengthen existing infrastructure in the TE hospitals based on facility survey;
 To purchase medical equipment pertaining to service delivery mentioned in the MoU;
 To standardize the existing Labour Room;
 To provide baby care rooms and other facility to meet emergencies of newborn;
 To appoint Doctors, Nurses and paramedical staff, if required;
Services Provided
 Mother & Child Care
 Provision of normal delivery
 Routine Ante- Natal & Post – Natal care to all women.
 Facility for New born Care such as neonatal resuscitation & management of neonatal
hypothermia/ jaundice
 Immunization of the children
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